OBJECTIVE: To apply risk compensation theory to naloxone peer access and evaluate whether reported naloxone protection—having naloxone and someone to administer it present when using unprescribed opioids—correlated with greater opioid overdose risk behaviors.
METHODS: Longitudinal cohort of 422 NYC residents using unprescribed opioids who completed at least three monthly surveys over 24 months. Mixed-effects models estimated unadjusted and adjusted associations between naloxone protection and both opioid risk and overdose events and were used to test whether race/ethnicity and gender modified the relationship between naloxone protection and risk behaviors.
RESULTS: Being protected 75% of the time or more was identified as a meaningful cutoff in the sample and was associated with fewer opioid risk behaviors and overdose events. Race/ethnicity, but not gender, was found to be a significant effect modifier of naloxone protection.
CONCLUSIONS: Findings indicate no support for the risk compensation-derived hypothesis that people who use opioids while protected by naloxone pursue more overdose-associated risk behaviors than those unprotected.
Higher levels of naloxone protection are associated with lower risk-taking: A longitudinal analysis of New York City residents using unprescribed opioids
Drug and Alcohol Dependence [Epub 2025 Nov 27]. doi: 10.1016/j.drugalcdep.2025.112989.